INTRODUCTION:
Rheumatic Heart Disease (RHD) remains a significant public health issue in underdeveloped settings in Sub-Saharan Africa. Key obstacles in targeting the problem include shortage of trained health professionals, limited community awareness and inadequate systems in place for the early detection and prevention of RHD. This study describes the adaption and leveraging of the World Heart Federation (WHF) strategy for education and prevention of RHD in Mozambique.

METHODS:
The Colours to Save Hearts Program in Mozambique was an interventional longitudinal prospective study developed using a multidisciplinary and multisectoral capacity building effort involving people living with RHD as facilitators of educational activities. Over four years we used i) a stepwise multicomponent approach that educated teachers, students, and health professionals; ii) large-scale school and community sensitization activities; and, iii) primary care detection, management and referral of sore throat streptococcal infections and RHD.

RESULTS:
We trained 1409 (95.7%) primary school teachers, who educated 75,181 (100%) and 1450 peer-educators primary school children, reaching their 472,680 family members. All frontline providers at primary care facilities were trained for diagnose and manage GAS sore throat and suspect RF/RHD. The RHD registry worked in 19 out of 23 schools (82,6%) and six out of eight health centres. Of the 610 children registered - 567 (93%) pharyngitis and 43 (7%) RF/RHD - most were initially signalled by family members. Overall 70 GAS sore throat were treated at primary care facilities. There were 43 referrals for suspected RF/RHD, but only 17 arrived to hospital and 3 cases of RHD were confirmed.

CONCLUSIONS:
Leveraging of the national school health programme and community-based educational interventions promoted awareness, early detection and referral of sore throat and RF/RHD in a resource-limited setting. Further research is warranted to further assess the impact of this strategy.